多发性骨髓瘤髓外病变的影像表现特点  

Imaging features of extramedullary disease in multiple myeloma

作　　者：吴美红 王龙胜[1] 郑穗生[1] 徐波 WU Meihong;WANG Longsheng;ZHENG Suisheng;XU Bo(Department of Radiology,the Second Affiliated Hospital of Anhui Medical University,Hefei 230000,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽合肥230000

出　　处：《实用放射学杂志》2019年第3期422-425,共4页Journal of Practical Radiology

摘　　要：目的探讨多发性骨髓瘤(MM)髓外病变(EMD)的影像表现特点。方法回顾性分析17例经病理确诊的MM伴发EMD的患者临床及影像学检查资料。结果 EMD有一定的好发部位,中枢神经系统侵犯6例:其中脑膜侵犯3例(单发2例,多发1例);椎管内单发侵犯1例;左侧颞极单发侵犯1例;左侧额部单发侵犯1例;头颈部单发侵犯3例;胸部侵犯8例:胸膜侵犯6例(多发5例,单发1例),肺内单发侵犯1例;前纵隔单发侵犯1例;皮下软组织多发侵犯5例;肌肉单发侵犯2例;淋巴结多发侵犯1例。CT和MRI均表现为软组织结节或肿块,CT值约30~70 HU,以30~45 HU多见,T1等或稍低信号,T2等或稍高信号,DWI呈高信号,增强后中度至明显强化,一般边界清晰,形态较规则,肌肉侵犯可呈浸润性生长。结论 MM EMD可以发生于任何部位,但以胸膜、脑膜及皮下软组织最为多见,CT及MRI可以很好地显示EMD的部位、大小、形态及与周围组织的关系,对EMD的诊断及鉴别诊断具有一定的参考价值。Objective To explore the imaging features of extramedullary disease(EMD) in multiple myeloma(MM).Methods The clinical and imaging data of 17 patienis with pathologically diagnosed MM combined with EMD were analyzed retrospectively.Results EMD had certain predilection sites,Central nervous system invasion ( 6 ): meningeal invasion ( 3 : 1 multiple, 2 focal), spinal canal invasion (1 focal), the left temporal pole invasion ( 1 focal), the left side forehead invasion! 1 focal);Head and neck invasion (3 :all focal);Thorax invasion (8): pleural invasi on (6:5 multiple, 1 focal), intrapulmonary invasion(1 focal), anterior mediastinal invasion) 1 focal);Subcutaneous soft tissue invasi on (5:all multiple);Muscle invasi on(2 focal);Lymph node invasion ( 1 multiple). Both CT and MRI showed soft tissue nodules or masses.The values of CT were about 30~70 HU,especially in 30~45 HU, while MRI presented equal or slightly low signal on T1WI, equal or slightly high signal on T2 WI ,and high signal in the sequence of DWI combined with moderate to obvious enhancement,Generally, the boundary of EMD were clear and the shape of these lesions were regular, However, the invasion to muscle in some lesions showed the pattern of invasive growth.Conclusion EMD of multiple myeloma may happen anywhere,and the pleural, meninges and subcutaneous soft tissues are the most common location.CT and MRI can show the EMD very well.The location, size,shape and relationship with surrounding tissues of these lesions have certain reference values for the diagnosis and differential diagnosis of EMD.

关 键 词：髓外病变 多发性骨髓瘤 计算机体层成像 磁共振成像 

分 类 号：R733.3[医药卫生—肿瘤] R814.42[医药卫生—临床医学]